Clinical Monitoring System V. 1.0
User Manual
September 1993
Department of Veterans Affairs
Office of Enterprise Development
Management & Financial Systems
Revision History
Initiated on 11/15/04
Date / Description (Patch # if applic.) / Project Manager / Technical Writer11/15/04 / Manual updated to comply with SOP 192-352 Displaying Sensitive Data / Corinne Bailey
2/23/09 / Reformatted Manual / Corinne Bailey
Table of Contents
Introduction 1
Orientation 3
Package Management 5
Monitoring System Manager Menu 7
Group Edit 8
Patient Group 9
Manually Run Auto Enroll 11
Rationale Edit 13
Site Parameters Edit 14
Build Monitor Menu 16
Enter/Edit a Monitor 16
Copy/Edit a Monitor 27
Quick Monitor Edit 29
Purge Menu 30
Auto Enroll Run Dates File Purge 30
Fall Out File Purge 31
History File Purge 32
Outputs Menu 33
Ad Hoc Fall Out Report 33
Ad Hoc Monitor Report 36
Audit File Inquire 39
Auto/Manual Enroll Monitors Run 40
Build a Monitor Worksheet 41
Condition File Inquire 45
Data Element File Inquire 46
Fall Out File Inquire 47
Group File Inquire 48
Monitor Description Report 49
Monitor History Report 51
Patients With Multiple Fall Outs 52
Monitoring System User Menu 53
Fall Out Edit 53
Sample Size Edit 54
Outputs Menu 55
Glossary 57
Option Index 61
Introduction
Introduction
The Clinical Monitoring System package is a fully integrated system compatible with Version 7.0 or later of Kernel and Version 19 or later of VA FileMan. The NEW PERSON file (#200) is required.
The heart of the Clinical Monitoring System package is in building monitors using conditions and groups for patient auto enrollment.
The main function of this software is to capture data for patients meeting specified conditions. All monitors within the framework of this software are ultimately based upon patient related data. In order to capture data, you create monitors that run nightly. These nightly runs "auto enroll" (or capture) the patients defined by the monitors.
This system looks at what happened yesterday in VistA. It can capture such items as ward, treating specialty, SSN, age, etc. For a more extensive list of items, use the Data Element File Inquire option within the Outputs Menu of the Monitoring System Manager Menu. Data elements available for capture vary depending on the conditions you select when building monitors.
Conditions are provided with the Clinical Monitoring System package. Examples of conditions include ON WARD, READMISSION, MAS MOVEMENT TYPE, PREVIOUS DISCHARGE, etc. You may use the Condition File Inquire option to obtain information on selected/all conditions. The information provided will describe the condition; tell you what questions will be asked when using a condition; tell you when you must define a group for the condition, and list the other data that is available for capture.
Each condition chosen for a monitor brings up a set of questions pertaining to it. For example, if you choose the AGE condition, you will be asked age ranges. Some conditions require a group be defined such as a group of wards, drug classes, MAS movement types, etc. Patients captured by the monitors are called "fall outs". With each condition used, there is a list of other data that can be captured when a patient becomes a “fall out” that might include items such as ward, admission date, attending, etc.
The monitors can be queued to run nightly, or manually run, one or more at a time. Each monitor has an "ON/OFF" switch, an "UNDER CONSTRUCTION" or "FINISHED" status, and START and STOP dates so that running it can be tightly controlled.
Software Features
· Provides the user with the ability to design a monitor that will auto enroll cases that meet the user's defined criteria/conditions from VistA.
· Allows the user to set time frames for computing percentages and tracking findings between time frames.
· Has the ability to alert users when important thresholds or dates are met.
· Provides a mechanism to add site-developed conditions and data elements and routines such as site-designed worksheets to the software. MUMPS programming is a required part of site-specific enhancement.
· Provides mechanisms for controlling the disk space and CPU time resources used by the Clinical Monitoring System.
· Allows the user to manually enter cases.
April 1995 AMIE V. 2.7 MAS User Manual 5
Introduction
Orientation
The format of this manual is summarized in the Table of Contents. The Glossary defines general terms relevant to the Clinical Monitoring System and computer use.
The software package uses basic VA FileMan. Refer to Users Guide to Computing for more in-depth help. The following summarizes some of the VA FileMan functions and conventions that are used within the Clinical Monitoring System package.
Exiting
Depending on where you are within the program, entering an "up-arrow" (compressing the shift key while striking the 6) will allow you to jump to the beginning of a new record or to the menu options. Then pressing the <RET> key until you pass through the different levels of the menus will exit you from the program or back to the menu option you wish to use.
Help (?, ??, or ???)
Whenever you are unclear on the definition of a menu option or on how to respond to a prompt, one, two, or three question marks may be entered to obtain an explanation.
Deleting
Deleting default answers that appear before a "//" or a "Replace" is done by entering @ (compressing the shift key while striking the 2). Refer to the Users Guide to Computing for instruction on deleting within word processing fields.
Device
Striking the <RET> (return) key following the "DEVICE:" prompt will print the requested output on the computer screen. If a "Right Margin" prompt shows, you will need to strike the <RET> key once again. Enter the name of the printer/device following the "DEVICE:" prompt to print a hard copy of the output.
Patient Look-ups
When prompted to enter a patient name, use at least the first two letters of the last name to identify the patient. You may also enter the first initial of the last name and the last four digits of the social security number to obtain a record on a specific patient.
Bold Print
Bold print is used throughout the documentation for all user input in the instructional portion of the manual.
<RET>
The <RET> symbol is used throughout the manual to designate the use of the return or enter key.
April 1995 AMIE V. 2.7 MAS User Manual 5
Introduction
Package Management
Personal data within the package is covered by the Privacy Act. Data from any monitors considered a quality assurance activity is considered confidential and privileged. Title 38 U.S.C. 5705, as amended by Public Law 99-166, and the implementing HSRO (Health Services Review Organization) regulations (Title 38 Part 17) provide that HSRO records and documents which refer to individual practitioners are confidential and privileged. Exempt from this protection are aggregate statistical data, such as trend reports that do not identify individual patients or employees. Access to the software should be restricted to those personnel who meet the site's established access criteria to data for the above purposes.
April 1995 AMIE V. 2.7 MAS User Manual 5
Monitoring System Manager Menu
Monitoring System Manager Menu
Group Edit
Patient Group
Manually Run Auto Enroll
Rationale Edit
Site Parameters Edit
Build Monitor Menu
Enter/Edit a Monitor
Copy/Edit a Monitor
Quick Monitor Edit
Purge Menu
Auto Enroll Run Dates File Purge
Fall Out File Purge
History File Purge
Outputs Menu
Ad Hoc Fall Out Report
Ad Hoc Monitor Report
Audit File Inquire
Auto/Manual Enroll Monitors Run
Build a Monitor Worksheet
Condition File Inquire
Data Element File Inquire
Fall Out File Inquire
Group File Inquire
Monitor Description Report
Monitor History Report
Patients With Multiple Fall Outs
Monitoring System User Menu
Fall Out Edit
Sample Size Edit
Outputs Menu
Ad Hoc Fall Out Report
Fall Out File Inquire
Monitor Description Report
Monitor History Report
Patients With Multiple Fall Outs
Group Edit
Introduction
The Group Edit option allows you to create groups of similar data from any VistA file that is in the QAM application group. First determine the conditions you want to use to build your monitor, and then see if within the definition of that condition you will need to define a group. This option is used only when the condition chosen to define a monitor calls for a group. For example, the Ward Location file contains all the wards at the site. You can select specific wards from this file to create a group. MAS Movement Type file contains movement types such as regular, irregular, discharge to CNH, death, etc. You could make a group of admissions to acute care by selecting the "Transfer In", "Direct", and "To ASIH" entries from the MAS Movement Type file.
Descriptions of the conditions are available through the Condition File Inquire option and can also be found in Appendix B of the ADPAC Guide. Use the condition descriptions to determine whether or not you need to define groups.
The Clinical Monitoring System software provides short-cuts so you do not always have to define groups. If, for example, you would like all MAS MOVEMENT TYPES that are “admission” transactions, you do not need to create a group containing all of the individual admission transaction MAS MOVEMENT TYPE entries. Instead, choose the MAS MOVEMENT TYPE condition when building your monitor. When asked which category of movement you are interested in, select "ADMISSIONS", then press <RET> at the group prompt.
Example
Select GROUP: SUBSTANCE ABUSE
Are you adding 'SUBSTANCE ABUSE' as a new GROUP (the 2ND)? No// Y (YES)
GROUP PARENT FILE: FACILITY TREATING SPECIALTY
NAME: SUBSTANCE ABUSE// <RET>
PARENT FILE: FACILITY TREATING SPECIALTY// (No Editing)
Select GROUP MEMBER: PSYCHIATRY
GROUP MEMBER: PSYCHIATRY// <RET>
Select GROUP MEMBER: <RET>
Patient Group
Introduction
This option allows the user to build a group of patients to monitor using the VA FileMan search option. Once the search and sort parameters have been input, the QAMDFM function must be used at one of the “print field” prompts. This function should be used on a field that is a pointer, free text pointer, or free text Patient Name field.
Usage: QAMFDN(Patient_name_Field) or QAMDFN(#Patient_name_Field_number)
This option can also be used to update an existing patient group. The file search would occur the same way as when creating a new patient group; however, you will be asked if the newly found entries should be merged with the existing entries or if the old entries should be deleted prior to the search.
If no group entries were created, the group will be deleted.
Example
We want to build a list of Dr. Brach's patients that had occurrences. Any file we search must have a Patient field that points to the PATIENT file. Dr. Brach is the attending so the Attending Physician field is searched for any entries containing BRACH.
Select GROUP: CMSPROVIDER,ONE’S PATIENTS
Are you adding 'CMSPROVIDER,ONE'S PATIENTS' as a new GROUP? No// Y (YES)
Select FILE TO SEARCH: 741 QA OCCURRENCE SCREEN
Searching the QA OCCURRENCE SCREEN file(#741)
-A- SEARCH FOR QA OCCURRENCE SCREEN FIELD: ATTENDING PHYSICIAN
-A- CONDITION: CONTAINS
-A- CONTAINS: CMSPROVIDER
-B- SEARCH FOR QA OCCURRENCE SCREEN FIELD: <RET>
IF:A// <RET> ATTENDING PHYSICIAN CONTAINS "CMSPROVIDER"
STORE RESULTS OF SEARCH IN TEMPLATE: <RET>
SORT BY: NUMBER// <RET>
START WITH NUMBER: FIRST// <RET>
FIRST PRINT FIELD: QAMDFN(QA PATIENT)
THEN PRINT FIELD: <RET>
Patient Group
Example
***********************
Heading (S/C): QA OCCURRENCE SCREEN SEARCH Replace <RET>
STORE PRINT LOGIC IN TEMPLATE: <RET>
DEVICE: <RET> HOME RIGHT MARGIN: 80// <RET>
QA OCCURRENCE SCREEN SEARCH JAN 19,1998 11:09 PAGE 1
QAMDFN(QA PATIENT)
------
NUMBER: 7
CMSPATIENT,ONE
NUMBER: 8
CMSPATIENT,TWO
NUMBER: 10
CMSPATIENT,THREE
NUMBER: 14
CMSPATIENT,FOUR
NUMBER: 18
CMSPATIENT,FIVE
5 MATCHES FOUND.
Building the CMSPROVIDER ONE’S PATIENTS group...
Manually Run Auto Enroll
Introduction
Active monitors are normally run as a nightly task as scheduled by IRM Service. This option allows the user to run selected monitors or selected services when, for some reason, one or more monitors has not run for a day. If a monitor has already been run for a given date in the past, the monitor will not rerun for that same day.
Auto enroll looks at VistA transactions from the previous day to capture fall outs. When auto enroll runs "tomorrow," it will only pick up fall outs with event dates of "today" not "yesterday" or any time before that. For example, fall outs with event dates of 1/4/98 will be picked up when auto enroll runs on 1/5/98.
For manually enrolled monitors, it is important to remember that it is the entry date, not the event date, that will determine whether or not the data will be auto enrolled. Therefore, a record entered manually today will be picked up by auto enroll tomorrow. (A manually enrolled monitor requires total manual entry of fall out data. See the Clinical Monitoring System ADPAC Guide for more details.)
Certain site parameters must contain entries before you may utilize this option. Depending on how the Manual Auto Run Allowed Times site parameter is set up, the manual run may only be performed at certain times during the day.
Example
Want to run auto enroll for specific monitors? No// <RET> (No)
Want to run auto enroll for specific services? No// <RET> (No)
Enter the date range you want auto enroll to scan
Monthly, Quarterly, Semi-Annually, Yearly, Fiscal Yearly, User Selectable
Select date range: USER SELECTABLE
Enter beginning and ending dates for the desired time period:
Beginning Date: 2 16 98 (FEB 16, 1998)
Ending Date: FEB 16,1998// <RET>98 (FEB 16, 1998)
Range selected: FEB 16,1998 to FEB 16,1998
Queue auto enroll to run at: N (FEB 17,1998@09:30)
Manually Run Auto Enroll
Example
Queueing auto enroll, please wait.
Want a report of the dates when auto enroll will run? YES// <RET> (Yes)
DEVICE: <RET> RIGHT MARGIN: 80// <RET>
MANUALLY QUEUED AUTO ENROLL RUN DATES FEB 17,1998
PERIOD FROM FEB 16,1998 TO FEB 16,1998 PAGE: 1
START DATE END DATE QUEUED TO RUN TASK NUMBER